| NPI | 1568711000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD458045) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.062280) |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2017-03-17 |